Benzodiazepine toxicity: Difference between revisions
(Text replacement - "benzos " to "benzodiazepines ") |
No edit summary |
||
| Line 4: | Line 4: | ||
==Clinical Features== | ==Clinical Features== | ||
*Somnolence, slurred speech, ataxia (similar to ETOH intoxication) | |||
*Paradoxical reaction (more common in hyperactive children, psychiatric patients) | |||
*Hypotension | |||
*Respiratory depression | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 15: | Line 15: | ||
==Management== | ==Management== | ||
*GI decontamination | |||
**[[Activated Charcoal]] x1 | |||
*Mechanical ventilation if necessary | |||
*Flumazenil | |||
**Controversial | |||
***May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure | |||
**Indication: | |||
***Consider (though controversial) for coma reversal | |||
**Contraindications: | |||
***Suspected or known physical dependence on benzodiazepines | |||
***Suspected TCA overdose | |||
***Co-ingestion of seizure-inducing agents | |||
***Known [[seizure]] disorder | |||
***Suspected increased intracranial pressure | |||
**Dosing | |||
***0.2mg IV; may repeat q1min (max dose 3mg) | |||
**Flumazenil-Induced Seizure | |||
***Treat with phenobarbital or propofol; benzodiazepines will not work | |||
*Withdrawal | |||
**High risk - GABA activity withdrawn | |||
***CNS excitation:agitation, tremor, hallucinations, seizures | |||
***Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis | |||
==Disposition== | ==Disposition== | ||
Revision as of 09:54, 11 March 2017
Background
- Isolated benzodiazepine overdose has low morbidity/mortality
- Coingestion or parenteral administration accounts for vast majority of deaths
Clinical Features
- Somnolence, slurred speech, ataxia (similar to ETOH intoxication)
- Paradoxical reaction (more common in hyperactive children, psychiatric patients)
- Hypotension
- Respiratory depression
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
Management
- GI decontamination
- Mechanical ventilation if necessary
- Flumazenil
- Controversial
- May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
- Indication:
- Consider (though controversial) for coma reversal
- Contraindications:
- Suspected or known physical dependence on benzodiazepines
- Suspected TCA overdose
- Co-ingestion of seizure-inducing agents
- Known seizure disorder
- Suspected increased intracranial pressure
- Dosing
- 0.2mg IV; may repeat q1min (max dose 3mg)
- Flumazenil-Induced Seizure
- Treat with phenobarbital or propofol; benzodiazepines will not work
- Controversial
- Withdrawal
- High risk - GABA activity withdrawn
- CNS excitation:agitation, tremor, hallucinations, seizures
- Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis
- High risk - GABA activity withdrawn
Disposition
- Consider discharge after 6hr obs